Chest X-ray demonstrated bilateral fluffy alveolar densities in midzone of the lungs and parahilar peribronchial infiltrations were also seen.High resolution computed tomography (HRCT) of the lung revealed bilateral nonhomogeneous ground glass opacities in mid and upper zones of the lungs.Mild bilateral peribronchial wall thickening was also seen. These findings were suggestive of PNEUMOCYSTIS JIROVECII Pneumonia.Smear of bronchoalveolar lavage (BAL) for PNEUMOCYSTIS was suspicious. Transbronchial biopsy revealed mild distortion of alveolar architecture and prominent intra-alveolar deposition of foamy eosinophilic exudates. Immuno-histochemistry staining with monoclonal antibody was strongly positive for PNEUMOCYSTIS.

PNEUMOCYSTIS JIROVECII pneumonia (PJP), formely called PNEUMOCYSTIS carinii pneumonia, is a serious disease in immunocompromised patients, particularly those with AIDS. However, many patients with this disease are unaware of their HIV serostatus, requiring early and prompt diagnosis of the disease. Early chest radiographic findings of PJP may be subtle or equivocal. On the other hand, advances in the treatment and prevention of the disease is associated with an increased rate of atypical manifestations, so it is important for radiologists to be familiar with the spectrum of imaging findings of the entity. The first report on imaging findings of PJP in a group of Iranian patients is presented.

Background: The human immunodeficiency virus (HIV) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of PNEUMOCYSTIS JIROVECII colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016. Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with PNEUMOCYSTIS admitted to Behavioral Counseling Center of Kermanshah. Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment. Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22. 8%) patients had PNEUMOCYSTIS. All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9– 186). The median CD4 count increased from 91 cells/mm 3 pre-trimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm 3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia. Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. JIROVECII infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease.

Introduction: PNEUMOCYSTIS pneumonia (PCP) is one of the most serious life threatening infections in patients with human immunodeficiency virus. It can also occur in immunosuppressed patients treated with immunosuppressive drugs. Immunocompetent adults can carryPNEUMOCYSTIS. The aim of this study was to identify PNEUMOCYSTIS JIROVECII in patients with pulmonary disorder. Materials and Methods: During 9 months (September 2014-May 2015), 138 Bronchoalveolar Lavage (BAL) samples obtained from patients undergone bronchoscopy referred to different departments of University Hospitals of Mashhad. Giemsa stained smear and molecular method performed for each sample. After DNA extraction, amplification of mitochondrial gene coding ribosomal large subunit (mtLSU-rRNA) ofP. JIROVECII was performed by Nested-PCR. To reconfirm diagnosis and definite identification, gene sequencing was performed. For statistical analysis t-test and chi-square tests were used, by using SPSS version 16. Results: By direct microscopy, P. JIROVECII was diagnosed in only 3(2. 2%) samples, but DNA was detected in 17 (12. 3%) by nested PCR. P. JIROVECII isolated from 10 (25%) immunosuppressed and 7 (7. 1%) of immunocompetent individuals. Fever, dyspnea and dry cough were the most common symptoms among patients with P. JIROVECII. Conclusion: P. JIROVECII is prevalent in immunodeficient patients compared to immunocompetent individuals. The latter group can act as reservoir of P. JIROVECII and can be an important source of infection for patients with pulmonary disorders.